ESPU Congress 2018 - Abstract Book

67 11–14 APRIL, 2018, HELSINKI, FINLAND 10:03–10:08 S6-7 (VP) RETROCAVAL URETER: AN UNEXPECTED INTRAOPERATIVE FINDING DURING ROBOTIC REDO PYELOPLASTY Hamdan ALHAZMI  1 , Santiago VALLASCIANI  2 , Abdulazeem ABASHER  2 , Saeed ALSHAHRANI  2 , Hossam ALJALLAD  2 , Ahmed ALMATHAMI  2 , Fadi AZAR  3 , Ahmad ALSHAMMARI  4 and Craig PETERS  5 1) King Saud University, King Saud University Medical City, Pediatric Urology Division, Department of Surgery, Riyadh, SAUDI ARABIA - 2) King Faisal Specialist Hospital and Research Center, Pediatric Urology Division, Urology Dept, Riyadh, SAUDI ARABIA - 3) King Faisal Specialist Hospital and Research Center, Nursing Department, Riyadh, SAUDI ARABIA - 4) National Guard Hospital, Pediatric Urology Division, Surgery Dept, Riyadh, SAUDI ARABIA - 5) Children's Medical Center, University of Texas Southwestern, Pediatric Urology Division, Surgery Dept, Dallas, USA PURPOSE Reoperative Pelvi Ureteric Junction obstruction (PUJO) cases are challenging due to the presence of scarring and anatomic distortion. In this video the unexpected intraoperative discovery of a high retrocaval ureter and its management are illustrated. MATERIAL AND METHODS a 3-year old male underwent open right Anderson-Hynes dismembered pyeloplasty through a flank incision at age 12 months. In 24 months of follow-up ultrasound and MAG3 scans revealed persistent severe hydronephrosis with an initially delayed washout pattern that bacame frankly ob- structed. Robotic redo pyeloplasty was recommended. Retrograde pyelogram revealed a S-shape proximal ureter with a short narrow segment. Using a 3-trocar robotic approach the proximal ureter was found to be surrounded by scar tissue and with an abnormal retrocaval course. The ureter and lower pelvis were mobilized carefully from behind the cava. The prior anatomosis was visibly patent. A dismembered pyeloplasty was done with anterior transposition and partial excision of the retrocaval ureter. DISCUSSION Reoperative pyeloplasty requires careful exposure of the proximal ureter and ureteropelvic junction to define the anatomy and determine the cause of the failure of the first procedure. The laparoscopic approach provides excellent vision and exposure of all the structures potentially involved in the recurrence. This case demonstrates the possibility of an unrecognized retrocaval ureter as a cause for pyeloplasty failure. CONCLUSION In the case presented, even if unexpected, the retrocaval course of the ureter was able to be man- aged with this approach. 10:08–10:20 Discussion